Senior Health Claims Adjudicator

About the role

We are looking for an experienced and detail‑oriented Senior Health Claims Adjudicator to join Guardian Life of the Caribbean Limited. In this position you will assess and adjudicate complex health insurance claims, ensure compliance with policy and regulatory requirements, and deliver fair, timely outcomes while supporting exceptional customer service.

Key responsibilities

• Coordinate review and processing of complex local, regional and overseas health claims in line with authorization limits and performance standards.
• Authorize all claims and precertifications that exceed the limits of Claim Adjudicators, including large or complex cases.
• Liaise with Medical Advisors, Aragon Agency and Technical Officers to determine overseas eligibility, pre‑existing conditions, medical necessity and verification of benefits.
• Manage overseas case eligibility, consult with medical and technical experts, and complete verification of benefits for insureds seeking treatment abroad.
• Handle client escalations promptly, make decisive decisions in time‑sensitive situations, and provide solution‑oriented resolutions.
• Assist in updating and maintaining claims processing procedures for health claims operations in Trinidad & Tobago and other jurisdictions.
• Provide training and mentorship to junior claims adjudicators.

Required profile

• Strong analytical mindset with high attention to detail.
• Proven experience adjudicating complex health insurance claims and precertifications.
• Thorough knowledge of policy, regulatory compliance and medical terminology.
• Ability to train and guide junior team members.
• Excellent communication and decision‑making skills, especially under pressure.

Required skills